The nurse is caring for a client with cardiomyopathy and coronary artery disease. The client is reporting increasing chest pain and has bilateral lung crackles on auscultation. The health care provider has written several new prescriptions. Which new prescription should the nurse clarify? Select all that apply.

Question

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Cardiomyopathy is a group of diseases in which the heart muscle (ie, myocardium) has a reduced ability to pump blood effectively, placing clients at risk for cardiogenic shock. Cardiogenic shock is manifested by reduced cardiac output (eg, hypotension, narrow pulse pressure), which can lead to pulmonary edema (eg, tachypnea, bibasilar crackles, decreased oxygen saturation) caused by blood "backing up" into the pulmonary capillaries. To compensate, catecholamines (eg, epinephrine) and vasopressin are released by the adrenal glands to increase cardiac output. However, this compensatory mechanism eventually fails, causing decreased perfusion and oxygenation of tissues as well as death. The client may need additional support with ionotropic agents (eg, norepinephrine) in these situations. Supplemental oxygen is appropriate for treatment given low oxygen saturation, chest pain, and tachypnea (Option C). If chest pain is present, obtaining an ECG and testing cardiac enzymes (eg, creatine kinase-MB, troponin I) are appropriate (Options D and E). (Option A) IV fluids should not be given rapidly (ie, bolused) in cardiogenic shock as this will suddenly increase circulating volume and cardiac workload, which may precipitate pulmonary edema. (Option B) Nitroglycerin can worsen hypotension and should be held. Other pain medications (eg, morphine) may be given for chest pain if blood pressure is low. Educational objective: Clients with cardiomyopathy may develop cardiogenic shock due to the heart's inability to circulate blood effectively, causing reduced cardiac output. Treatment of cardiogenic shock includes supplemental oxygen, an ECG, cardiac enzyme testing, and interventions to reduce cardiac workload.

The Nurse Is Caring for a Client with Cardiomyopathy and Coronary